Article: Goitre

A goitre (or goiter) (Latin struma), also called a bronchocele, is a swelling in the neck (just below adam's apple or larynx) due to an enlarged thyroid gland. They are classified in different ways:

• A "diffuse goitre" is a goitre that has spread through all of the thyroid (and is contrasted with a "simple goitre", "single thyroid nodule" and "multinodular goitre".
• "Toxic goitre" refers to goitre with hyperthyroidism. These are derived from inflammation, neoplasm, and some kinds of activating autoimmune disease (Grave's disease). "Nontoxic goitre" (associated with normal or low thyroid levels) refers to all other types (such as that caused by lithium or certain other autoimmune diseases).

Causes

The most common cause for goitre in the world is iodine deficiency (E01), which causes goitre in a widespread way in an iodine deficient population. This is commonly called endemic goitre. It is curable by mass food-supplementation with iodine (in the form of iodide or iodate), and today remains a problem only in the least affluent countries which lack economic resources to fortify foods with iodine as part of public health programs.

Other causes are:

• Hashimoto's thyroiditis (E06.3)
• Graves-Basedow disease (E05.0)
• Juvenile goitre due to congenital hypothyroidism (E03.0)
• Neoplasm of the thyroid
• Thyroiditis (acute, chronic) (E06)
• Side-effects of pharmacological therapy (E03.2)

Occurrence

Iodine is necessary for the synthesis of the thyroid hormones triiodothyronine and thyroxine (T3 and T4). In conditions producing endemic goitre, when iodine is not available, these hormones cannot be made. In response to low thyroid hormones, the pituitary gland releases thyroid stimulating hormone (TSH). Thyroid stimulating hormone acts to increase synthesis of T3 and T4, but in excess it also causes the thyroid gland to grow in size as a type of compensation.

Goitre is more common among women, but this includes the many types of goitre caused by autoimmune problems, and not only those caused by simple lack of iodine.

Treatment for goitre may not be necessary if the goitre is not caused by disease and is small. Removal of the goitre may be necessary if it causes difficulty with breathing or swallowing. But removal of certain types of diffuse goitre mentioned above will result in removing the entire thyroid as well. The complete removal of the thyroid gland destroys the body's ability to produce thyroid hormone. In this case, supplements of oral thyroid hormone are necessary to avoid harm from hypothyroidism.

History and future

Goitre was previously common in many areas that were deficient in iodine in the soil. For example, in the English Midlands, the condition was known as Derbyshire Neck. In the United States, goiter was found in the Great Lakes, Midwest, and Intermountain regions. The condition now is practically absent in affluent nations, where table salt is supplemented with iodine. However, it is still prevalent in Central Asia and Central Africa.

Some health workers fear that a resurgence of goiter might occur because of the trend to use rock salt and/or sea salt, which has not been fortified with iodine.

New research indicates that there may in fact be a tendency to inherit an increased vulnerability to goitre.

Famous Goitre Sufferers

• Frank Sinatra
• David Hasselhoff
• President George H. W. Bush and his wife Barbara Bush both were diagnosed with Grave's disease and enlarged thyroid glands, within 2 years of each other. In the president's case, the disease caused hyperthyoidism and a heart dysrhythmia [1]
• Andrea True